Hormonal Eligibility Criteria for ‘Includes Females' Competition: A Practical but Problematic Solution

Abstract

The International Association of Athletics Federations (IAAF) and the International Olympic Committee (IOC) adopted testosterone level criteria for eligibility (i.e. 10 nmol/l or 290 ng/dl in blood for IAAF, levels ‘within the male range' for IOC) to compete in the ‘includes females' category. The policies address the assertion that women with very high endogenous testosterone (unless they are androgen-resistant) have an unfair advantage over women with lower natural levels. Recently, the Court of Arbitration for Sport suspended the ‘hyperandrogenism regulation' by the IAAF, but added: ‘since there are separate categories of male and female competition, it is necessary for the IAAF to formulate a basis for the division of athletes into male and female categories for the benefit of the broad class of female athletes. The basis chosen should be necessary, reasonable and proportionate to the legitimate objective being pursued' [Branch J: Dutee Chand, Female Sprinter with High Testosterone Level, Wins Right to Compete. The New York Times, July 27, 2015]. An analysis of available evidence below - scientific as well as experiential - suggests that androgen-based criteria can, in fact, be rationally defended as the best currently available and practical approach to determine eligibility for competition in the ‘includes females' category. However, to justify such policies, the IOC and IAAF must also show them to be not only rational, but also fair, necessary, and consistent with the treatment of athletes with other endogenous non-physiologic advantages.

Female hyperandrogenism and elite sport

“…However, an exception is CAIS, since in this case the individual cannot respond to testosterone although she has testosterone in the male range. These rules, designed to preserve the safety, fairness and integrity of women's competition, and in no way to determine sex or gender, have been subjected to debate and criticism (63,64,65,66,67,68).…”

Do anabolic-androgenic steroids have performance-enhancing effects in female athletes?

“…In April 2011, the IAAF and the IOC revised their policies to allow female athletes with DSDs or hyperandrogenism to participate in international competitions as long as their circulating serum testosterone levels are below the lower limit for men (<10 nmol/L); the exception to this rule included those women who are resistant to the effects of testosterone (due to inactivating mutations of the androgen receptor) or who undergo interventions to reduce serum testosterone levels (orchiectomy or hormone-suppressing drugs) below the male threshold (Sanchez et al, 2013; Sonksen et al, 2015; Xavier and McGill, 2012). These regulations were met with some skepticism as there is lack of concrete scientific evidence showing that endogenous hyperandrogenism in women significantly influences physical performance (Allen, 2016; Bermon et al, 2014; Healy et al, 2014; Sonksen et al, 2015). In July 2016, the Court of Arbitration for Sport ruled that the IAAF policy was not justified based on the current scientific evidence; however; the Court did acknowledge that naturally elevated endogenous serum testosterone levels may play some role in female athleticism.…”

Biological Sex, Gender, and Public Policy

“…In part for this reason, after other attempts at sex testing failed, contemporary policies about who can compete in women’s sports have been based on maximum acceptable levels of testosterone in women. This is based on the assumption that higher testosterone enhances athletic ability, and accounts for a sex gap in athletic performance (Allen, 2016; Karkazis & Jordan-Young, 2015; Wood & Stanton, 2012). What is the science?…”

“…But little is actually known about endogenous testosterone levels in women, leaving much room for speculation and ideology to fill the place of biology (Fausto-Sterling, 2000; van Anders et al, 2014). Regardless, androgen-based policies have assigned a maximum testosterone level for women to compete as women in sport, often describing it as the “normal” lower limit of men’s endogenous testosterone (Allen, 2016). However, men do not have a normal lower limit of testosterone: Levels reach as low as those in women and overlap between women and men more than presumed (Sánchez, Martinez-Patiño, & Vilain, 2013).…”